Management of metastatic HER2-positive breast cancer progression after adjuvant trastuzumab therapy – current evidence and future trends

Abstract

Trastuzumab is now considered the standard of care for the adjuvant treatment of human epidermal growth factor receptor-2 (HER2)-positive breast cancer patients, yet a sizable number of HER2-positive patients do not benefit from this treatment. For patients who progress on or after completion of adjuvant trastuzumab therapy, the standard of care is uncertain. Newer tyrosine kinase inhibitors and monoclonal antibodies are being evaluated in clinical trials for optimisation of treatment in this group. The interplay of HER2 and hormonal signalling pathways is being manipulated to see if response rates can be bettered. In this reveiw we explain the present role of the new molecules with a case scenario. The new anti-HER2 drugs have the potential to change clinical practise of targeting HER2 in the future. Better understanding of HER2 functions and interactions of different signalling pathways will be essential for optimal targetted therapies.

Keywords::

• adjuvant therapy
• chemotherapy
• human epidermal growth factor receptor-2 (HER2)
• metastatic breast cancer
• trastuzumab
• tyrosine kinase inhibitors

Acknowledgements

This paper is published as part of a supplement forming the Proceedings of the 5th Annual Conference of the Organisation for Oncology and Translational Research (OOTR). Publication of this supplement is supported by an educational grant from GlaxoSmithKline Ltd. The 5th Annual Conference of OOTR was supported by the following sponsors: GlaxoSmithKline; Pfizer; Novartis; Sanofi-aventis; Roche; AstraZeneca; Genomic Health; Wyeth; Orient Europharma; Medicom; Tin Hang Technology; MacKay Medical Group; Macau Tourism Board.